Biased-Track Revolover Loading Surgical Clip Applier

ABSTRACT

An end effector for a surgical clip applier includes a body having, a clip revolver rotatably coupled within a bore of the body and containing one or more surgical clips, a torsion member constrained between the body and the clip revolver to exert rotational force on the clip revolver, and a clip advancer that is slidingly coupled within an inner bore of the clip revolver. The inner bore of the clip revolver includes a plurality of grooves in which the clip advancer may translate. The clip advancer aligns with a distal-most surgical clip as it travels within a first of the grooves. The torsion member rotates the clip revolver as the clip advancer travels distally from the first groove so that the clip advancer travels into a second groove of the grooves, such that the clip advancer is in alignment with a second distal-most surgical clip.

BACKGROUND

Minimally invasive surgical (MIS) instruments are often preferred overtraditional open surgical devices due to reduced post-operative recoverytime and minimal scarring. Endoscopic surgery is one type of MISprocedure in which an elongate flexible shaft is introduced into thebody of a patient through a natural orifice. Laparoscopic surgery isanother type of MIS procedure in which one or more small incisions areformed in the abdomen of a patient and a trocar is inserted through theincision to form a pathway that provides access to the abdominal cavity.Through the trocar (i.e., a trocar cannula), a variety of instrumentsand surgical tools can be introduced into the abdominal cavity to engageand/or treat tissue in a number of ways to achieve a diagnostic ortherapeutic effect.

One surgical instrument commonly used with a trocar is a surgical clipapplier, which can be used to ligate blood vessels, ducts, shunts, orportions of body tissue during surgery. Traditional surgical clipappliers have a handle and an elongate shaft extending from the handle.A pair of movable opposed jaws is positioned at the end of the elongateshaft for holding and forming a surgical clip or “ligation clip”therebetween. In operation, a user (e.g., a surgeon or clinician)positions the jaws around the vessel or duct and squeezes a trigger onthe handle to close the jaws and thereby collapse the surgical clip overthe vessel.

More recently, however, robotic systems have been developed to assist inMIS procedures. Instead of directly engaging a surgical instrument,users are now able to manipulate and engage surgical instruments via anelectronic interface communicatively coupled to a robotic manipulator.With the advances of robotic surgery, a user need not even be in theoperating room with the patient during the surgery.

Robotic surgical systems are also now capable of utilizing roboticallycontrolled clip appliers. Such clip appliers include features forrobotically feeding and forming surgical clips. Advances andimprovements to the methods and devices for applying surgical clips tovessels, ducts, shunts, etc. is continuously in demand to make theprocess more efficient and safe.

BRIEF DESCRIPTION OF THE DRAWINGS

The following figures are included to illustrate certain aspects of thepresent disclosure, and should not be viewed as exclusive embodiments.The subject matter disclosed is capable of considerable modifications,alterations, combinations, and equivalents in form and function, withoutdeparting from the scope of this disclosure.

FIG. 1 is a block diagram of an example robotic surgical system that mayincorporate some or all of the principles of the present disclosure.

FIG. 2 is an isometric top view of an example surgical tool that mayincorporate some or all of the principles of the present disclosure.

FIG. 3 is an isometric bottom view of the surgical tool of FIG. 2.

FIG. 4 is an exploded view of the elongate shaft and the end effector ofthe surgical tool of FIGS. 2 and 3.

FIG. 5 is an exposed isometric view of the surgical tool of FIG. 2.

FIG. 6 is a side view of an example surgical tool that may incorporatesome or all of the principles of the present disclosure.

FIG. 7 illustrates potential degrees of freedom in which the wrist ofFIG. 1 may be able to articulate (pivot).

FIG. 8 is an enlarged isometric view of the distal end of the surgicaltool of FIG. 6.

FIG. 9 is a bottom view of the drive housing of the surgical tool ofFIG. 6.

FIG. 10 is an isometric exposed view of the interior of the drivehousing of the surgical tool of FIG. 6.

FIG. 11 is an exposed, partial cross-sectional side view of an exampleend effector.

FIG. 12 is an enlarged isometric view of the revolver of the endeffector of FIG. 11.

FIG. 13 is an isometric exposed view of the interior of the drivehousing of the surgical tool of FIG. 11.

FIGS. 14A-14E are progressive exposed, partial isometric views of theend effector of FIG. 11 during example operation.

FIG. 15 is an enlarged isometric view of another example end effector.

FIG. 16 is an exposed, partial cross-sectional side view of the revolverof the end effector of FIG. 15.

FIGS. 17A-17B are progressive exposed, partial isometric views of theend effector of FIG. 15 during an example reloading operation.

DETAILED DESCRIPTION

The present disclosure is related to surgical systems and, moreparticularly, to surgical clip appliers with rotating clip cartridgesand feeder bars that selectively feed surgical clips between opposed jawmembers.

Embodiments discussed herein describe improvements to clip applier endeffectors. Some end effector embodiments described herein include a bodyhaving a clip revolver that is rotatably coupled within the body nearits distal end and containing one or more surgical clips. An indexer maybe slidingly coupled within the body to engage the revolver and causerotation thereof, and a feeder bar may be arranged within the body andextend through the revolver and the indexer to feed surgical clipsdistally. The body may include a rotation region that defines aplurality of rails, and a biasing member may be arranged within therotation region such that the revolver is constrained between thebiasing member and the rails. A first cam surface may be arranged at adistal end of the indexer and a second cam surface that corresponds withthe first cam surface may be arranged at a proximal end of the revolver.In example operation, the indexer is actuated in a distal directionuntil the first cam surface thereof engages the second cam surface ofthe revolver, which pushes the revolver in a distal direction until itclears the rails within the rotation region after which the biasingmember causes the revolver to rotate into position where one of thesurgical clips is in alignment with the feeder bar.

Other end effector embodiments disclosed herein describe an elongatebody, a revolver that holds a plurality of surgical clips, a pusher thatarticulates within the revolver to selectively engage each surgicalclip, and a torsion member that is arranged around the revolver andsecured at one end to the elongate body. The revolver may include aplurality of grooves that each align with one of the surgical clips, andthe pusher may be configured to travel (traverse) within such groovesthereby constraining rotation of the revolver. The torsion member mayexert a force on the revolver and thus urge rotation of the revolver.Rotation of the revolver via the torsion member may be generallyinhibited when the pusher is positioned in a distal region of thegrooves. However, as the pusher travels proximally, the grooves may eachopen into a channel that leads and connects to another of the groovessuch that stored mechanical energy in the torsion member may be releasedto cause revolver rotation. Thus, as the pusher travels proximate to thechannels, the torsion member may rotate the revolver such that thepusher travels into the channel, and then into another of the grooves tothereby index the revolver.

In contrast to conventional clip appliers, the revolver that holds thesurgical clips may be arranged at a location distal to an articulablewrist joint, which helps mitigate obstructions that would otherwiseimpede the surgical clips having to traverse the wrist. Moreover, thepresently described revolver embodiments may be configured to storesurgical clips arrayed in a nested helically arrayed arrangement, whichfacilitates storage of a larger number of clips resulting in the toolsneeding to be reloaded or replaced less often during operation.

FIG. 1 is a block diagram of an example robotic surgical system 100 thatmay incorporate some or all of the principles of the present disclosure.As illustrated, the system 100 can include at least one mastercontroller 102 a and at least one arm cart 104. The arm cart 104 may bemechanically and/or electrically coupled to a robotic manipulator and,more particularly, to one or more robotic arms 106 or “tool drivers”.Each robotic arm 106 may include and otherwise provide a location formounting one or more surgical tools or instruments 108 for performingvarious surgical tasks on a patient 110. Operation of the robotic arms106 and instruments 108 may be directed by a clinician 112 a (e.g., asurgeon) from the master controller 102 a.

In some embodiments, a second master controller 102 b (shown in dashedlines) operated by a second clinician 112 b may also direct operation ofthe robotic arms 106 and instruments 108 in conjunction with the firstclinician 112 a. In such embodiments, for example, each clinician 102a,b may control different robotic arms 106 or, in some cases, completecontrol of the robotic arms 106 may be passed between the clinicians 102a,b. In some embodiments, additional arm carts (not shown) havingadditional robotic arms (not shown) may be utilized during surgery on apatient 110, and these additional robotic arms may be controlled by oneor more of the master controllers 102 a,b.

The arm cart 104 and the master controllers 102 a,b may be incommunication with one another via a communications link 114, which maybe any type of wired or wireless telecommunications means configured tocarry a variety of communication signals (e.g., electrical, optical,infrared, etc.) according to any communications protocol.

The master controllers 102 a,b generally include one or more physicalcontrollers that can be grasped by the clinicians 112 a,b andmanipulated in space while the surgeon views the procedure via a stereodisplay. The physical controllers generally comprise manual inputdevices movable in multiple degrees of freedom, and which often includean actuatable handle for actuating the surgical instrument(s) 108, forexample, for opening and closing opposing jaws, applying an electricalpotential (current) to an electrode, or the like. The master controllers102 a,b can also include an optional feedback meter viewable by theclinicians 112 a,b via a display to provide a visual indication ofvarious surgical instrument metrics, such as the amount of force beingapplied to the surgical instrument (i.e., a cutting instrument ordynamic clamping member).

Example implementations of robotic surgical systems, such as the system100, are disclosed in U.S. Pat. No. 7,524,320, the contents of which areincorporated herein by reference. The various particularities of suchdevices will not be described in detail herein beyond that which may benecessary to understand the various embodiments and forms of the variousembodiments of robotic surgery apparatus, systems, and methods disclosedherein.

FIG. 2 is an isometric top view of an example surgical tool 200 that mayincorporate some or all of the principles of the present disclosure. Thesurgical tool 200 may be the same as or similar to the surgicalinstrument(s) 108 of FIG. 1 and, therefore, may be used in conjunctionwith the robotic surgical system 100 of FIG. 1. Accordingly, thesurgical tool 200 may be designed to be releasably coupled to a roboticarm 106 (FIG. 1) of a robotic manipulator of the robotic surgical system100. Full detail and operational description of the surgical tool 200 isprovided in U.S. Patent Pub. 2016/0287252, entitled “Clip ApplierAdapted for Use with a Surgical Robot,” the contents of which are herebyincorporated by reference in their entirety.

While the surgical tool 200 is described herein with reference to arobotic surgical system, it is noted that the principles of the presentdisclosure are equally applicable to non-robotic surgical tools or, morespecifically, manually operated surgical tools. Accordingly, thediscussion provided herein relating to robotic surgical systems merelyencompasses one example application of the presently disclosed inventiveconcepts.

As illustrated, the surgical tool 200 can include an elongate shaft 202,an end effector 204 coupled to the distal end of the shaft 202, and adrive housing 206 coupled to the proximal end of the shaft 202. Theterms “proximal” and “distal” are defined herein relative to a roboticsurgical system having an interface configured to mechanically andelectrically couple the surgical tool 200 (e.g., the drive housing 206)to a robotic manipulator. The term “proximal” refers to the position ofan element closer to the robotic manipulator and the term “distal”refers to the position of an element closer to the end effector 204 andthus further away from the robotic manipulator. Moreover, the use ofdirectional terms such as above, below, upper, lower, upward, downward,left, right, and the like are used in relation to the illustrativeembodiments as they are depicted in the figures, the upward or upperdirection being toward the top of the corresponding figure and thedownward or lower direction being toward the bottom of the correspondingfigure.

In applications where the surgical tool 200 is used in conjunction witha robotic surgical system (e.g., system 100 of FIG. 1), the drivehousing 206 can include a tool mounting portion 208 designed withfeatures that releasably couple the surgical tool 200 to a robotic arm(e.g., the robotic arms 106 or “tool drivers” of FIG. 1) of a roboticmanipulator. The tool mounting portion 208 may releasably attach(couple) the drive housing 206 to a tool driver in a variety of ways,such as by clamping thereto, clipping thereto, or slidably matingtherewith. In some embodiments, the tool mounting portion 208 mayinclude an array of electrical connecting pins, which may be coupled toan electrical connection on the mounting surface of the tool driver.While the tool mounting portion 208 is described herein with referenceto mechanical, electrical, and magnetic coupling elements, it should beunderstood that a wide variety of telemetry modalities might be used,including infrared, inductive coupling, or the like.

FIG. 3 is an isometric bottom view of the surgical tool 200. Thesurgical tool 200 further includes an interface 302 that mechanicallyand electrically couples the tool mounting portion 208 to a roboticmanipulator. In various embodiments, the tool mounting portion 208includes a tool mounting plate 304 that operably supports a plurality ofdrive inputs, shown as a first drive input 306 a, a second drive input306 b, and a third drive input 306 c. While only three drive inputs 306a-c are shown in FIG. 3, more or less than three may be employed,without departing from the scope of the disclosure.

In the illustrated embodiment, each drive input 306 a-c comprises arotatable disc configured to align with and couple to a correspondinginput actuator (not shown) of a given tool driver. Moreover, each driveinput 306 a-c provides or defines one or more surface features 308configured to align with mating surface features provided on thecorresponding input actuator. The surface features 308 can include, forexample, various protrusions and/or indentations that facilitate amating engagement.

FIG. 4 is an exploded view of one example of the elongate shaft 202 andthe end effector 204 of the surgical tool 200 of FIGS. 2 and 3,according to one or more embodiments. As illustrated, the shaft 202includes an outer tube 402 that houses the various components of theshaft 202, which can include a jaw retaining assembly 404. The jawretaining assembly 404 includes a jaw retainer shaft 406 with a cliptrack 408 and a push rod channel 410 formed thereon. The end effector204 includes opposing jaws 412 that are configured to mate to a distalend of the clip track 408.

The shaft 202 also includes a clip advancing assembly, which, in oneexample embodiment, can include a feeder shoe 414 adapted to be slidablydisposed within the clip track 408. The feeder shoe 414 is designed toadvance a series of clips 416 positioned within the clip track 408, anda feedbar 418 is adapted to drive the feeder shoe 414 through the cliptrack 408. An advancer assembly 420 is adapted to mate to a distal endof the feedbar 418 for advancing a distal-most clip into the jaws 412.

The shaft 202 furthers include a clip forming or camming assemblyoperable to collapse the jaws 412 and thereby crimp (crush) a surgicalclip 416 positioned between (interposing) the jaws 412. The cammingassembly includes a cam 422 that slidably mates to the jaws 412, and apush rod 424 that moves the cam 422 relative to the jaws 412 to collapsethe jaws 412. A tissue stop 426 can mate to a distal end of the cliptrack 408 to help position the jaws 412 relative to a surgical site.

The jaw retainer shaft 406 is extendable within and couples to the outertube 402 at a proximal end 428 a, and its distal end 428 b is adapted tomate with the jaws 412. The push rod channel 410 formed on the jawretainer shaft 406 may be configured to slidably receive the push rod424, which is used to advance the cam 422 over the jaws 412. The cliptrack 408 extends distally beyond the distal end 428 b of the jawretainer shaft 406 to allow a distal end of the clip track 408 to besubstantially aligned with the jaws 412.

The clip track 408 can include several openings 430 formed therein forreceiving an upper or “superior” tang 432 a formed on the feeder shoe414 adapted to be disposed within the clip track 408. The clip track 408can also include a stop tang 434 formed thereon that is effective to beengaged by a corresponding stop tang formed on the feeder shoe 414 toprevent movement of the feeder shoe 414 beyond a distal-most position.To facilitate proximal-movement of the feeder shoe 414 within the cliptrack 408, the feeder shoe 414 can also include a lower or “inferior”tang 432 b formed on the underside thereof for allowing the feeder shoe414 to be engaged by the feedbar 418 as the feedbar 418 is moveddistally. In use, each time the feedbar 418 is moved distally, a detentformed in the feedbar 418 engages the inferior tang 432 b and moves thefeeder shoe 414 distally a predetermined distance within the clip track408. The feedbar 418 can then be moved proximally to return to itsinitial position, and the angle of the inferior tang 432 b allows theinferior tang 432 b to slide into the next detent formed in the feedbar418.

The jaws 412 include first and second opposed jaw members that aremovable (collapsible) relative to one another and are configured toreceive a surgical clip from the series of clips 416 therebetween. Thejaw members can each include a groove formed on opposed inner surfacesthereof for receiving the legs of a surgical clip 416 in alignment withthe jaw members. In the illustrated embodiment, the jaw members arebiased to an open position and a force is required to urge the jawmembers toward one another to crimp the interposing clip 416. The jawmembers can also each include a cam track formed thereon for allowingthe cam 422 to slidably engage and move the jaw members toward oneanother. A proximal end 436 a of the cam 422 is matable with a distalend 438 a of the push rod 424, and a distal end 436 b of the cam 422 isadapted to engage and actuate the jaws 412. The proximal end 438 b ofthe push rod 424 is matable with a closure link assembly associated withthe drive housing 206 for moving the push rod 424 and the cam 422relative to the jaws 412.

The distal end 436 b of the cam 422 includes a camming channel ortapering recess formed therein for slidably receiving corresponding camtracks provided by the jaw members. In operation, the cam 422 isadvanced from a proximal position, in which the jaw members are spacedapart from one another, to a distal position, where the jaw members arecollapsed to a closed position. As the cam 422 is advanced over the jawmembers, the tapering recess at the distal end 436 b serves to push thejaw members toward one another, thereby crimping a surgical clip 416disposed therebetween.

FIG. 5 is an exposed isometric view of the surgical tool 200 of FIG. 2,according to one or more embodiments. The shroud or covering of thedrive housing 206 has been removed to reveal the internal componentparts. As illustrated, the surgical tool 200 may include a first drivegear 502 a, a second drive gear 502 b, and a third drive gear 502 c. Thefirst drive gear 502 a may be operatively coupled to (or extend from)the first drive input 306 a (FIG. 3) such that actuation of the firstdrive input 306 a correspondingly rotates the first drive gear 502 a.Similarly, the second and third drive gears 502 b,c may be operativelycoupled to (or extend from) the second and third drive inputs 306 b,c(FIG. 3), respectively, such that actuation of the second and thirddrive inputs 306 b,c correspondingly rotates the second and third drivegears 502 b,c, respectively.

The first drive gear 502 a may be configured to intermesh with a firstdriven gear 504 a, which is operatively coupled to the shaft 202. In theillustrated embodiment, the driven gear 504 a comprises a helical gear.In operation, rotation of the first drive gear 502 a about a first axiscorrespondingly rotates the first driven gear 504 a about a second axisorthogonal to the first axis to control rotation of the shaft 202 inclockwise and counter-clockwise directions based on the rotationaldirection of the first drive gear 502 a.

The second drive gear 502 b may be configured to intermesh with a seconddriven gear 504 b (partially visible in FIG. 5), and the third drivegear 502 c may be configured to intermesh with a third driven gear 504c. In the illustrated embodiment, the second and third drive and drivengears 502 b,c, 504 b,c comprise corresponding rack and pinioninterfaces, where the driven gears 504 b,c comprise the rack and thedrive gears 502 b,c comprise the pinion. Independent rotation of thesecond and third drive gears 502 b,c will cause the second and thirddriven gears 504 b,c, respectively, to translate linearly relative to(independent of) one another.

In at least one embodiment, actuation (rotation) of the third drive gear502 c will result in a surgical clip 416 (FIG. 4) being fed into thejaws 412. More particularly, the third driven gear 504 c may beoperatively coupled to the feedbar 418 (FIG. 4) and, upon rotation ofthe third drive gear 502 c in a first angular direction, the thirddriven gear 504 c will advance distally and correspondingly advance thefeedbar 418 a sufficient distance to fully advance a surgical clip intothe jaws 412. Rotation of the third drive gear 502 c may be preciselycontrolled by an electrical and software interface to deliver the exactlinear travel to the third driven gear 504 c necessary to feed a clip416 into the jaws 412.

Upon delivery of a clip into the jaws 412, or after a predeterminedamount of rotation of the third drive gear 502 c, rotation of the thirddrive gear 502 c is reversed in a second angular direction to move thethird driven gear 504 c linearly in a proximal direction, whichcorrespondingly moves the feedbar 418 proximally. This process may berepeated several times to accommodate a predetermined number of clipsresiding in the shaft 202.

Actuation of the second drive gear 502 b causes the jaws 412 to close orcollapse to crimp a surgical clip. More particularly, the second drivengear 504 b may be coupled to the proximal end 438 b (FIG. 4) of the pushrod 424 (FIG. 4) and, upon actuation of the second drive gear 502 b in afirst angular direction, the second driven gear 504 b will be advancedlinearly in a distal direction and correspondingly drive the push rod424 distally, which drives the cam 422 over the jaws 412 to collapse thejaw members and crimp a surgical clip positioned in the jaws 412. Once asurgical clip is successfully deployed, rotation of the second drivegear 502 b is reversed in the opposite angular direction to move thesecond driven gear 504 b in a proximal direction, which correspondinglymoves the push rod 424 and the cam 422 proximally and permits the jaws412 to open once again.

The processes of delivering a surgical clip into the jaws 412 andcollapsing the jaws 412 to crimp the surgical clip are not limited tothe actuation mechanisms and structures described herein. In alternativeembodiments, for example, the second and third driven gears 504 b,c mayinstead comprise capstan pulleys configured to route and translate drivecables within the shaft 202. In such embodiments, the drive cables maybe operatively coupled to one or more lead screws or other types ofrotating members positioned within the shaft 202 near the distal end andcapable of advancing the feedbar 418 to deliver a surgical clip into thejaws 412 and advancing the cam 422 to collapse the jaws 412 and crimpthe surgical clip.

FIG. 6 is an isometric top view of another example surgical tool 600that may incorporate some or all of the principles of the presentdisclosure. Similar to the surgical tool 200 of FIG. 2, the surgicaltool 600 may be used in conjunction with the robotic surgical system 100of FIG. 1. As illustrated, the surgical tool 600 includes an elongateshaft 602, an end effector 604 positioned at the distal end of the shaft602, an articulating joint 606 (alternately referred to as a“articulable wrist joint”) that couples the end effector 604 to thedistal end of the shaft 602, and a drive housing 608 coupled to theproximal end of the shaft 602. In some embodiments, the shaft 602, andhence the end effector 604 coupled thereto, is configured to rotateabout a longitudinal axis A₁.

In the illustrated embodiment, the end effector 604 comprises a clipapplier that includes opposing jaw members 610, 612 configured tocollapse toward one another to crimp a surgical clip. The articulatingjoint 606 facilitates pivoting movement of the end effector 604 relativeto the shaft 602 to position the end effector 604 at desiredorientations and locations relative to a surgical site. The housing 608includes (contains) various actuation mechanisms designed to controlarticulation at the articulating joint 606 and operation of the endeffector 604.

FIG. 7 illustrates the potential degrees of freedom in which thearticulating joint 606 may be able to articulate (pivot). The degrees offreedom of the articulating joint 606 are represented by threetranslational variables (i.e., surge, heave, and sway), and by threerotational variables (i.e., Euler angles or roll, pitch, and yaw). Thetranslational and rotational variables describe the position andorientation of a component of a surgical system (e.g., the end effector604) with respect to a given reference Cartesian frame. As depicted inFIG. 7, “surge” refers to forward and backward translational movement,“heave” refers to translational movement up and down, and “sway” refersto translational movement left and right. With regard to the rotationalterms, “roll” refers to tilting side to side, “pitch” refers to tiltingforward and backward, and “yaw” refers to turning left and right.

The pivoting motion can include pitch movement about a first axis of thearticulating joint 606 (e.g., X-axis), yaw movement about a second axisof the articulating joint 606 (e.g., Y-axis), and combinations thereofto allow for 360° rotational movement of the end effector 604 about thearticulating joint 606. In other applications, the pivoting motion canbe limited to movement in a single plane, e.g., only pitch movementabout the first axis of the articulating joint 606 or only yaw movementabout the second axis of the articulating joint 606, such that the endeffector 604 moves only in a single plane.

Referring again to FIG. 6, the surgical tool 600 includes a plurality ofdrive cables (generally obscured in FIG. 6) that form part of a cabledriven motion system configured to facilitate operation and articulation(movement) of the end effector 604 relative to the shaft 602. Forexample, selectively moving the drive cables can actuate the endeffector 604 and thereby collapse the jaw members 610, 612 toward eachother. Moreover, moving the drive cables can also move the end effector604 between an unarticulated position and an articulated position. Theend effector 604 is depicted in FIG. 6 in the unarticulated positionwhere a longitudinal axis A₂ of the end effector 604 is substantiallyaligned with the longitudinal axis A₁ of the shaft 602, such that theend effector 604 is at a substantially zero angle relative to the shaft602. In the articulated position, the longitudinal axes A₁, A₂ would beangularly offset from each other such that the end effector 604 is at anon-zero angle relative to the shaft 602.

FIG. 8 is an enlarged isometric view of the distal end of the surgicaltool 600 of FIG. 6. More specifically, FIG. 8 depicts an enlarged andpartially exploded view of the end effector 604 and the articulatingjoint 606. The articulating joint 606 operatively couples the endeffector 604 to the shaft 602. To accomplish this, the articulatingjoint 606 includes a distal clevis 802 a, a proximal clevis 802 b, and aspacer 803 interposing the distal and proximal clevises 802 a,b. The endeffector 604 is coupled to the distal clevis 802 a and the distal clevis802 a is rotatably mounted to the spacer 803 at a first axle 804 a. Thespacer 803 is rotatably mounted to the proximal clevis 802 b at a secondaxle 804 b and the proximal clevis 802 b is coupled to a distal end 806of the shaft 602.

The articulating joint 606 provides a first pivot axis P₁ that extendsthrough the first axle 804 a and a second pivot axis P₂ that extendsthrough the second axle 804 b. The first pivot axis P₁ is substantiallyperpendicular (orthogonal) to the longitudinal axis A₂ of the endeffector 604, and the second pivot axis P₂ is substantiallyperpendicular (orthogonal) to both the longitudinal axis A₂ and thefirst pivot axis P₁. Movement about the first pivot axis P₁ provides“yaw” articulation of the end effector 604, and movement about thesecond pivot axis P₂ provides “pitch” articulation of the end effector604.

A plurality of drive cables 808 extend longitudinally within the shaft602 and pass through the wrist 106 to be operatively coupled to the endeffector 604. The drive cables 808 form part of the cable driven motionsystem briefly described above, and may be referred to and otherwisecharacterized as cables, bands, lines, cords, wires, ropes, strings,twisted strings, elongate members, etc. The drive cables 808 can be madefrom a variety of materials including, but not limited to, metal (e.g.,tungsten, stainless steel, etc.) or a polymer.

The drive cables 808 extend proximally from the end effector 604 to thedrive housing 608 (FIG. 6) where they are operatively coupled to variousactuation mechanisms or devices housed (contained) therein to facilitatelongitudinal movement (translation) of the drive cables 808. Selectiveactuation of the drive cables 808 causes the end effector 604 toarticulate (pivot) relative to the shaft 602. Moving a given drive cable808 constitutes applying tension (i.e., pull force) to the given drivecable 808 in a proximal direction, which causes the given drive cable808 to translate and thereby cause the end effector 604 to move(articulate) relative to the shaft 602.

One or more actuation cables 810, shown as first actuation cables 810 aand second actuation cables 810 b, may also extend longitudinally withinthe shaft 602 and pass through the wrist 106 to be operatively coupledto the end effector 604. The actuation cables 810 a,b may be similar tothe drive cables 808 and also form part of the cable driven motionsystem. Selectively actuating the actuation cables 810 a,b causes theend effector 604 to actuate, such as collapsing the first and second jawmembers 610, 612 to crimp a surgical clip (not shown).

More specifically, the actuation cables 810 a,b may be operativelycoupled to a cam 812 that is slidably engageable with the jaw members610, 612. One or more pulleys 814 may be used to receive and redirectthe first actuation cables 810 a for engagement with the cam 812.Longitudinal movement of the first actuation cables 810 acorrespondingly moves the cam 812 distally relative to the jaw members610, 612. The distal end of the cam 812 includes a tapering recess orcamming channel 816 formed therein for slidably receiving correspondingcam tracks 818 provided by the jaw members 610, 612. As the cam 812 isadvanced distally, the camming channel 816 pushes (collapses) the jawmembers 610, 612 toward one another, thereby crimping a surgical clip(not shown) disposed therebetween. Actuation of the second actuationcables 810 b (one shown) pulls the cam 812 proximally, thereby allowingthe jaw members 610, 612 to open again to receive another surgical clip.

Although not expressly depicted in FIG. 8, an assembly including, forexample, a feedbar, a feeder shoe, and a clip track may be included ator near the end effector 604 to facilitate feeding surgical clips intothe jaw members 610, 612. In some embodiments, the feedbar (or aconnecting member) may be flexible and extend through the articulatingjoint 606.

FIG. 9 is a bottom view of the drive housing 608, according to one ormore embodiments. As illustrated, the drive housing 608 may include atool mounting interface 902 used to operatively couple the drive housing608 to a tool driver of a robotic manipulator. The tool mountinginterface 902 may mechanically, magnetically, and/or electrically couplethe drive housing 608 to a tool driver.

As illustrated, the interface 902 includes and supports a plurality ofdrive inputs, shown as drive inputs 906 a, 906 b, 906 c, 906 d, 906 e,and 906 f. Each drive input 906 a-f may comprise a rotatable discconfigured to align with and couple to a corresponding input actuator(not shown) of a tool driver. Moreover, each drive input 906 a-fprovides or defines one or more surface features 908 configured to alignwith mating features provided on the corresponding input actuator. Thesurface features 908 can include, for example, various protrusionsand/or indentations that facilitate a mating engagement.

In some embodiments, actuation of the first drive input 906 a maycontrol rotation of the elongate shaft 602 about its longitudinal axisA₁. Depending on the rotational actuation of the first drive input 906a, the elongate shaft 602 may be rotated clockwise or counter-clockwise.In some embodiments, selective actuation of the second and third driveinputs 906 b,c may cause movement (axial translation) of the actuationcables 810 a,b (FIG. 8), which causes the cam 812 (FIG. 8) to move andcrimp a surgical clip, as generally described above. In someembodiments, actuation of the fourth drive input 906 d feeds a surgicalclip into the jaw members 610, 612 (FIG. 8). In some embodiments,actuation of the fifth and sixth drive inputs 906 e,f causes movement(axial translation) of the drive cables 808 (FIG. 8), which results inarticulation of the end effector 604. Each of the drive inputs 906 a-fmay be actuated based on user inputs communicated to a tool drivercoupled to the interface 902, and the user inputs may be received via acomputer system incorporated into the robotic surgical system.

FIG. 10 is an isometric exposed view of the interior of the drivehousing 608, according to one or more embodiments. Several componentparts that may otherwise be contained within the drive housing 608 arenot shown in FIG. 10 to enable discussion of the depicted componentparts.

As illustrated, the drive housing 608 contains a first capstan 1002 a,which is operatively coupled to or extends from the first drive input906 a (FIG. 9) such that actuation of the first drive input 906 aresults in rotation of the first capstan 1002 a. A helical drive gear1004 is coupled to or forms part of the first capstan 1002 a and isconfigured to mesh and interact with a driven gear 1006 operativelycoupled to the shaft 602 such that rotation of the driven gear 1006correspondingly rotates the shaft 602. Accordingly, rotation of thehelical drive gear 1004 (via actuation of the first drive input 906 a ofFIG. 9) will drive the driven gear 1006 and thereby control rotation ofthe elongate shaft 602 about the longitudinal axis A₁.

The drive housing 608 also includes second and third capstans 1002 b and1002 c operatively coupled to or extending from the second and thirddrive inputs 906 b,c (FIG. 9), respectively, such that actuation of thesecond and third drive inputs 906 b,c results in rotation of the secondand third capstans 1002 b,c. The second and third capstans 1002 b,ccomprise capstan pulleys operatively coupled to the actuation cables 810a,b (FIG. 8) such that rotation of a given capstan 1002 b,c actuates(longitudinally moves) a corresponding one of the actuation cables 810a,b. Accordingly, selective rotation of the second and third capstans1002 b,c via actuation of the second and third drive inputs 906 b,c,respectively, will cause movement (axial translation) of the actuationcables 810 a,b, which causes the cam 812 (FIG. 8) to move and crimp asurgical clip.

The drive housing 608 further includes a fourth capstan 1002 d, which isoperatively coupled to or extends from the fourth drive input 906 d(FIG. 9) such that actuation of the fourth drive input 906 d results inrotation of the fourth capstan 1002 d. A spur gear 1008 is coupled to orforms part of the fourth capstan 1002 d and is configured to mesh andinteract with a rack gear (not shown) also contained within the drivehousing 608. The rack gear may be operatively coupled to a feedbar (oranother connecting member) which facilitates operation of a feeder shoeand associated clip track to feed surgical clips into the jaw members610, 612 (FIGS. 6 and 8). Accordingly, rotation of the spur gear 1008(via actuation of the fourth drive input 906 d) will control the feedbarand thereby control loading of surgical clips into the jaw members 610,612 as desired.

The drive housing 608 further contains or houses fifth and sixthcapstans 1002 e and 1002 f operatively coupled to or extending from thefifth and sixth drive inputs 906 e,f (FIG. 9), respectively, such thatactuation of the fifth and sixth drive inputs 906 e,f results inrotation of the fifth and sixth capstans 1002 e,f. The fifth and sixthcapstans 1002 e,f comprise capstan pulleys operatively coupled to thedrive cables 808 (FIG. 8) such that rotation of a given capstan 1002 e,factuates (longitudinally moves) a corresponding one of the actuationcables 808. Accordingly, selective rotation of the fifth and sixthcapstans 1002 e,f via actuation of the fifth and sixth drive inputs 906e,f, respectively, will cause movement (axial translation) of the drivecables 808 and thereby articulate (pivot) the end effector 604 relativeto the shaft 602.

The surgical tools 200, 600 described herein above may incorporate andfacilitate the principles of the present disclosure in improving feedingand/or forming of surgical clips in robotic or non-robotic clipappliers. Moreover, it is contemplated herein to combine some or all ofthe features of the surgical tools 200, 600 to facilitate operation ofthe embodiments described below. Accordingly, example surgical toolsthat may incorporate the principles of the present disclosure mayinclude geared actuators, capstan pulley and cable actuators, or anycombination thereof, without departing from the scope of the disclosure.

FIG. 11 is an enlarged isometric cross-sectional view of an example endeffector 1102, according to one or more embodiments of the presentdisclosure. The end effector 1102 may be similar in some respects to theend effectors 204 and 604 of FIGS. 2 and 6, respectively. Similar to theend effectors 204, 604, for example, the end effector 1102 may beincorporated into either or both of the surgical tools 200, 600described herein above. In addition, the end effector 1102 may comprisea clip applier having opposed jaw members 1104 and 1106 configured tocollapse toward one another to crimp a surgical clip 1108 (four shown ina stacked arrangement). As described herein, the end effector 1102 mayincorporate various component parts and actuatable mechanisms orfeatures that facilitate the feeding of the surgical clip(s) 1108 intothe opposed jaw members 1104,1106 and collapsing the opposed jaw members1104,1106 to crimp the surgical clip(s) 1108 when desired. Moreover, thecorresponding inner surfaces of each of the opposed jaw members1104,1106 may define or otherwise provide a groove 1104′,1106′ thattogether define a path, slot, or track that the surgical clips 1108 maytravel as they are pushed or fed into interposition between the opposedjaw members 1104,1106, as hereinafter described.

As illustrated, the end effector 1102 extends along a longitudinal axisA₃ and includes an elongate body 1110 having a proximal end 1112 a and adistal end 1112 b. The jaw members 1104,1106 extend out of or otherwisepast the distal end 1112 b. In addition, the end effector 1102 includesa revolver 1114, a biasing member 1116, an indexer 1118, and a clipadvancer 1120 (referred to hereinafter as an “advancer”) that are eacharranged within the body 1110. The indexer 1118 and the pusher 1120 maybe longitudinally actuatable (movable) to cause the revolver 1114 toindex (rotate) and thereby selectively discharge a surgical clip 1108housed within the revolver 1114. To accomplish this, the indexer 1118and the pusher 1120 may be operatively coupled to a drive input of adrive housing, such as one of the drive housings 206, 608 of FIGS. 2 and6, respectively. In such embodiments, for example, the indexer 1118 andthe pusher 1120 may be operatively coupled to the second and third driveand driven gears 502 b,c, 504 b,c of FIG. 5 or one or more of therotatable capstans 1002 b-f of FIG. 10.

The surgical clips 1108 may be housed within the revolver 1114, and theindexer 1118 may be actuatable to longitudinally translate to engage andindex the revolver 1114. Indexing the revolver 1114 selectivelyfacilitates sequential axial alignment of each surgical clip 1108 withthe opposed jaw members 1104,1106, as hereinafter described. Thereafter,the pusher 1120 may be actuatable to discharge and deploy the alignedsurgical clip 1108 from the revolver 1114 and into interposition betweenthe opposed jaw members 1104,1106 where it can be crimped.

As illustrated, the body 1110 is generally cylindrical and hollow.Consequently, the body 1110 defines a bore 1113 that extends the lengthof the end effector 1102, from the proximal end 1112 a to the distal end1112 b. As described below, the bore 1113 may comprise various regionsor compartments that house or otherwise accommodate the revolver 1114,the indexer 1118, and the pusher 1120. The body 1110 defines an annularflange 1122 at the distal end 1112 b and an interior surface 1115 of thebore 1113 extends proximally therefrom. In some embodiments, theproximal end 1112 a may be operatively coupled to an elongate shaft of asurgical tool, such as the shaft 202 of the surgical tool 200 of FIG. 2.In other embodiments, however, the proximal end 1112 a may beoperatively coupled to an articulable wrist joint, such as the wrist 606of the surgical tool 600 of FIG. 6.

The revolver 1114 includes a proximal end 1124 a and a distal end 1124b. The revolver 1114 may be hollow to accommodate the surgical clips1108 at or near the distal end 1124 b. Each surgical clip 1108 includesa crown 1108′ (alternately referred to as an “apex”) and a pair of legs1108″ extending longitudinally from the crown 1108′. As illustrated, thesurgical clips 1108 are stored within the clip revolver 1114 in a nestedhelical array. As used herein in conjunction with the stackingarrangement of the surgical clips 1108, the phrase “nested helicalarray” refers to the surgical clips 1108 being arranged (stacked) withthe crown of the more proximal surgical clips 1108 stacked upon (or inclose proximity to) the crown of the more distal surgical clips, and thelegs of the more proximal surgical clips 1108 extending past the crownof the more distal surgical clips 1108, and where the legs of all thesurgical clips 1108 extend substantially parallel to the longitudinalaxis A₃. Moreover, “nested helical array” also refers to the surgicalclips 1108 being stacked such that they are angularly offset from eachother. More specifically, the surgical clips 1108 are stacked such thateach successive surgical clip 1108 resides in a different radial planerelative to the longitudinal axis A₃. Accordingly, the surgical clips1108 are arranged within the clip revolver 1114 with the legs 1108″leading towards the jaw members 1104,1106 and the crown 1108′ extendingproximally therefrom. As a result, the surgical clips 1108 are fed legs1108″ first into the jaw members 1104,1106.

The revolver 1114 provides a plurality of cams 1126 defined at theproximal end 1124 a. Each cam 1126 defines a corresponding cammingsurface 1126′ engageable with the indexer 1118 to effect rotation of therevolver 1114, as described below. The revolver 1114 also provides orotherwise defines a plurality of guides 1128 arranged on an outer radialsurface thereof. The guides 1128 are outwardly protruding features thatare positioned between the proximal and distal ends 1124 a,1124 b,distal of the cams 1126, and may be equidistantly spaced about the outerradial surface of the revolver 1114. Each guide 1128 may define acamming surface 1128′ and, in some embodiments, each guide 1128 mayaxially align with a corresponding one of the cams 1126 such that thecamming surfaces 1126′,1128′ have corresponding orientations. Therevolver 1114 is further described below with reference to FIG. 12.

As mentioned above, the bore 1113 of the body 1110 includes one or morediscrete internal regions or compartments that are formed into the body1110. In the illustrated embodiment, the bore 1113 defines or provides arevolver compartment 1130 and an indexer compartment 1140 that eachextend along the longitudinal axis A₃. Here, the revolver compartment1130 is proximate to the distal end 1112 b and exhibits an increaseddiameter section of the bore 1113 that extends proximally from theannular flange 1122. The indexer compartment 1140 is located proximal tothe revolver compartment 1130. The revolver 1114 and the indexer 1118are disposed within the body 1110 and are each arranged to slide ortranslate along the longitudinal axis A₃ at least partially into therevolver compartment 1130 and the indexer compartment 1140. The revolver1114 is also arranged to rotate about the longitudinal axis A₃. Rotatingthe revolver 1114 may be configured to sequentially align each surgicalclip 1108 with the opposed jaw members 1104,1106.

The revolver compartment 1130 includes a proximal region 1132 a and adistal region 1132 b, where the distal region 1132 b extends proximallyfrom an interior lip 1134 of the annular flange 1122 and terminates atthe indexer compartment 1140. The indexer compartment 1140 includes aproximal region 1142 a and a distal region 1142 b, where the distalregion 1142 b extends proximally from the revolver compartment 1130. Inthe illustrated embodiment, the indexer compartment 1140 has a smallerdiameter than the revolver compartment 1130, thereby defining a distallyfacing annular face 1142 b′ that marks the intersection of the revolvercompartment 1130 and the indexer compartment 1140.

The revolver compartment 1130 includes a plurality of camming grooves1136 defined in the body 1110 and sized to slidably receive the guides1128. In the illustrated embodiment, the camming grooves 1136 areaxially aligned with and otherwise extend parallel to the longitudinalaxis A₃, but they may alternatively have different orientations in otherembodiments. Similar to the guides 1128, the camming grooves 1136 may beequidistantly spaced about the inner surface of the body 1110. Moreover,the number of guides 1128 and camming grooves 1136 may be generally thesame, but could be different in alternative embodiments.

The revolver 1114 and the indexer 1118 may translate relative to therevolver compartment 1130 and the indexer compartment 1140 without beingcaught, impeded, or obstructed by the distally facing annular face 1142b′ or any other protruding corners or edges formed at the intersectionof the camming grooves 1136 and the indexer compartment 1140. Eachcamming groove 1136 may also define a camming surface 1136′ at a distalend thereof that is engageable with a corresponding one of the cammingsurfaces 1128′ of the guides 1128. Accordingly, the camming surfaces1136′ of the camming grooves 1136 and the camming surfaces 1128′ may besubstantially alignable when the revolver 1114 rotates (indexes) and mayexhibit corresponding and complementary geometries. In addition, thecamming surfaces 1136′,1128′ may also be cooperatively angled ororiented to help properly orient the guides 1128 within the camminggrooves 1136.

Each camming groove 1136 may be configured to receive a correspondingone of the guides 1128 and thereby direct the revolver 1114 along a pathdefined by the geometry of the corresponding camming grooves 1136. Morespecifically, the camming grooves 1136 extend longitudinally and guidethe revolver 1114 along a linear path when the guides 1128 are fullyreceived therein. Thus, as the revolver 1114 translates proximally intothe proximal region 1132 a of the revolver compartment 1130, the guides1128 are received within the camming grooves 1136 so that the revolver1114 travels linearly without rotation. As the revolver 1114 travelsdistally during operation, the guides 1128 will eventually exit thecamming grooves 1136 to allow the revolver 1114 to rotate (index).

The indexer compartment 1140 is configured to receive the indexer 1118,at least when the end effector 1102 is unactuated, such that the indexer1118 may slide therein. In addition, the indexer compartment 1140 maypartially receive the revolver 1114 during operation. Here, the cams1126 of the revolver 1114 may extend into the distal region 1142 b ofthe indexer compartment 1140, for example, when the end effector 1102 isunactuated.

The indexer 1118 may be configured to travel (reciprocate) within theindexer compartment 1140. To help guide and orient the indexer 1118 asit translates within the indexer compartment 1140, the body 1110 maydefine one or more indexer guides 1144 (one shown). In the illustratedembodiment, the indexer guides 1144 are channels, recesses, or tracksthat are formed into the inner surface of the indexer compartment 1140and extend longitudinally. The indexer guides 1144 may be configured toslidably receive one or more corresponding indexer rails 1148 (twoshown) provided on the outer radial surface of the indexer 1118 andthereby orient the indexer 1118 as it travels between the proximalregion 1142 a and the distal region 1142 b.

While the illustrated embodiment includes a pair of indexer rails 1148,it will be appreciated that more or less may be utilized, depending onthe number of indexer guides 1144. Also, while the indexer rails 1148are illustrated as being oriented with the longitudinal axis A₃ andextending from a proximal end 1146 a to a distal end 1146 b of theindexer 1118, the indexer rails 1148 may alternatively exhibit differentgeometries. For example, one or both of the indexer rails 1148 may bereplaced with one or more pins or protrusions that are receivable withinthe indexer guides 1144. In even other embodiments, the indexer rails1148 may be provided as recesses (grooves) configured to receivecorresponding indexer guides 1144 in the form of protrusions.

The indexer guides 1144 may direct the indexer 1118 along variouspredetermined paths. Here, the indexer guides 1144 are linear (extendlongitudinally) and thus inhibit rotation of the indexer 1118 about thelongitudinal axis A₃. In other embodiments, however, the indexer guides1144 may be non-linear and extend helically around the inner surface.

As mentioned, the indexer 1118 may be operatively coupled to a driveinput of a drive housing (e.g., one of the drive housings 206, 608 ofFIGS. 2 and 6, respectively). The proximal end 1146 a of the indexer1118 may be operatively connected to one or more members extendingthrough the elongate shaft 202, 602 (FIGS. 2 and 6, respectively) suchthat it may be actuated. For example, the proximal end 1146 a may beattached to a thrust shaft that extends through the length of theelongate shaft 202, 602 and may extend from one of the drive inputsincluded in the drive housing. However, the indexer 1118 may bedifferently reciprocated without departing from the present disclosure.Upon actuation, the indexer 1118 may be moved distally within the bore1113 of the body 1110 and thereby engage and cause the revolver 1114 toindex (rotate).

The indexer 1118 causes the revolver 1114 to index by engaging the cams1126 of the revolver 1114. In the illustrated embodiment, the indexer1118 includes a plurality of cams 1150 disposed on the distal end 1146 bof the indexer 1118, and each cam 1150 defines a camming surface 1150′configured to engage a corresponding one of the camming surfaces 1126′of the revolver 1114. The camming surfaces 1126′,1150′ may havecorresponding geometries and orientations. Upon actuation of the endeffector 1102, the indexer 1118 may translate distally to engage therevolver 1114 by engaging the cams 1150 of the indexer 1118 against thecams 1126 of the revolver 1114.

Similar to the indexer 1118, the pusher 1120 may be operatively coupledto a drive input of a drive housing (e.g., one of the drive housings206, 608 of FIGS. 2 and 6, respectively) such that, upon actuation, itis caused to move (e.g., reciprocate) within the bore 1113 to deploy asurgical clip 1108 from the revolver 1114 and into the opposed jawmembers 1104,1106. The revolver 1114 may be configured to index suchthat a distal-most surgical clip 1108 becomes axially aligned with thepusher 1120 and is simultaneously placed in alignment with the opposedjaw members 1104,1106. In the illustrated embodiment, the pusher 1120may be configured to enter and translate distally through the indexer1118 and the revolver 1114 to locate and apply an axial load on analigned surgical clip 1108.

In the illustrated embodiment, the pusher 1120 includes a pusher shaft1170 having a proximal end 1172 a and a distal end 1172 b. In someembodiments, the proximal end 1172 a may extend to a drive housing whereit may be operatively coupled to a drive input configured to actuate(longitudinally drive) the pusher 1120. In some embodiments, the pusher1120 may be bifurcated at the distal end 1172 b and thereby provide apair of opposed pushing elements 1174,1176 that extend distally from thedistal end 1172 b. The pushing elements 1174,1176 may be generallyaligned with the opposed jaw members 1104,1106, respectively.

The biasing member 1116 imparts a force on the revolver 1114 that helpsfacilitate repeated indexing of the revolver 1114 as it is alternatinglyengaged and disengaged by the indexer 1118. In the illustratedembodiment, the biasing member 1116 is a spring 1160; however, it willbe appreciated that the biasing member 1116 may instead comprisedifferent materials or devices capable of providing a biasing force,without departing from the present disclosure. Here, the spring 1160 isprovided in the distal region 1132 b of the revolver compartment 1130,and arranged around the distal end 1124 b of the revolver 1114. Thespring 1160 extends between the annular flange 1122 and the guides 1128and thus provides a passive biasing load on the revolver 1114 in theproximal direction.

The spring 1160 acts on the revolver 1114 to help facilitate rotationand indexing of the revolver 1114. More specifically, the spring 1160biases the revolver 1114 proximally where its guides 1128 are fullyengaged in the camming grooves 1136. When the indexer 1118 is distallytranslated, it engages and advances the revolver 1114 distally. Thespring 1160 applies a counteracting force that maintains engagement ofthe camming surfaces 1126′,1150′ of the revolver 1114 and indexer 1118,respectively. As the revolver 1114 advances distally, engagement betweenthe camming grooves 1136 and the guides inhibit rotation of the revolver1114. However, once the guides 1128 exit the camming grooves 1136, therevolver 1114 is able to rotate (index) as the corresponding cammingsurfaces 1126′,1150′ slidably interact. The inclination (angle) of thecamming surfaces 1126′,1150′ causes the revolver 1114 to simultaneouslytranslate in a proximal direction such that the guides 1128 becomeangularly aligned with angularly adjacent camming grooves 1136. Once therevolver 1114 is properly indexed, a penultimate surgical clip 1108becomes aligned with the opposed jaws 1104,1106 for deployment by thepusher 1120. As will be appreciated, this indexing action is similar insome respects to the operation of a click-action ballpoint pen.

FIG. 12 is an enlarged isometric view of the revolver 1114, according toone or more embodiments. The revolver 1114 is hollow and includes aninner bore 1200 extending from the proximal end 1124 a to the distal end1124 b thereof. As illustrated, the inner bore 1200 defines a clipchamber 1202 designed to hold/store the surgical clips 1108. The clipchamber 1202 also orients the surgical clips 1108 to be deployed legs1108″ first by the pusher 1120 (FIG. 11). Here, the clip chamber 1202extends into the inner bore 1200 from the distal end 1124 b. As will beappreciated, the distance that the clip chamber 1202 extends into theinner bore 1200 may depend on the length of the surgical clips 1108 andthe number of surgical clips 1108 capable of being nested therein.

The clip chamber 1202 includes a plurality of clip slots 1204 definedinto the inner surface of the inner bore 1200. Each clip slot 1204 maybe configured to receive one leg of a given surgical clip 1108 and maybe angularly opposite an opposing clip slot 1204 configured to receivethe second leg of the given surgical clip 1108. Consequently, a pair ofangularly opposite clips slots 1204 may be configured to receive andseat a single surgical clip 1108. In the illustrated embodiment, theclip chamber 1202 includes eight clip slots 1204 equidistantly spacedabout the inner bore 1200 and therefore capable of receiving acorresponding four surgical clips 1108 stacked in a helical array. Itwill be appreciated, however, that more or less than four surgical clips1108 may be accommodated within the revolver 1114 without departing fromthe present disclosure. The angular spacing and orientation of the clipslots 1204 helps the surgical clips 1108 to be arranged in a nestedhelical array, as illustrated.

As illustrated, the helically arrayed surgical clips 1108 are stacked(nested) one on top of the other from the proximal end 1124 a towardsthe distal end 1124 b. Here, the surgical clips 1108 include aproximal-most clip 1208 a, a distal-most clip 1208 d, and twointermediate clips 1208 b,1208 c. The surgical clips 1208 a-d arearranged within the clips slots 1204 such that each surgical clip 1208a-d resides in a different radial plane relative to the longitudinalaxis A₃ of the end effector 1102 (FIG. 1) and, therefore, the surgicalclips are angularly offset from each other. In operation, the revolver1114 may be rotated to align the distal-most clip 1208 d with theopposed jaw members 1104,1106 for deployment. Following deployment ofthe distal-most clip 1208 d, the end effector 1102 (FIG. 11) may beactuated again to rotate the revolver 1114 and thereby align thepenultimate clip 1208 c for deployment. This process may be repeateduntil the revolver 1114 is rotated to align the proximal-most clip 1208a with the jaw members 1104,1106 for deployment.

FIG. 12 also includes depicts the distal end 1129 of the guides 1128. Asindicated above, the spring 1160 (FIG. 11) may be configured to engagethe distal end 1129 of each guide 1128. In at least one embodiment, thedistal end 1129 of each guide 1128 may be contoured and otherwiseconfigured to receive the spring 1160 in a secure manner that inhibitsslipping. However, in other embodiments, the distal ends 1129 mayinclude different surface finishes or none at all.

FIG. 13 is an isometric exposed view of the interior of an exampleembodiment of the drive housing 608, according to one or moreembodiments. Various internal components of the drive housing 608 havebeen removed to view devices capable of actuating the indexer 1118 andthe pusher 1120. In the illustrated embodiment, a linear actuator 1300may be utilized to actuate the indexer 1118, which causes the revolver1114 (FIGS. 11 and 12) to index (rotate).

As illustrated, the linear actuator 1300 may include a thrust shaft 1302that includes a proximal end 1304 a and a distal end 1304 b. Here, thethrust shaft 1302 extends through the elongate shaft 602, with theproximal end 1304 a extending into the drive housing 608 and the distalend 1304 b being attached to the proximal end 1146 a of the indexer1118. While the indexer 1118 is described herein as being operativelycoupled to the thrust shaft 1302, it is contemplated herein that theindexer 1118 may alternatively form an integral part or extension of thethrust shaft 1302, without departing from the scope of the disclosure.

The linear actuator 1300 may also include a rack gear 1306 attached tothe proximal end 1304 of the thrust shaft 1302 and configured to meshand interact with the spur gear 1008 operatively coupled to the fourthcapstan 1002 d. Accordingly, rotation of the spur gear 1008 (viaactuation of the fourth drive input 906 d of FIG. 9) will control thethrust shaft 1302 and thereby control indexing of the revolver 1114(FIGS. 11 and 12). It will be appreciated, however, that the thrustshaft 1302 may be differently configured, for example to be actuated byany of the other capstans and corresponding drive inputs and/or with adifferent gearing assembly, without departing from the presentdisclosure.

The pusher 1120 may be actuated separately from the indexer 1118, ortimed to deploy a surgical clip 1108 (FIGS. 11 and 12) after therevolver 1114 (FIGS. 11 and 12) has indexed the surgical clip 1108 intoalignment with the opposed jaw members 1104,1106 (FIG. 11) as desired.In the illustrated embodiment, the thrust shaft 1302 is hollow and thepusher 1120 extends through the thrust shaft 1302, with the proximal end1172 a of the pusher shaft 1170 extending into the drive housing 608 andthe distal end 1172 b of the pusher shaft 1170 extending distallytherefrom to a location proximate to the indexer 1118. In addition, afirst link member 1310 is coupled to or forms part of the third capstan1002 c such that they rotate in unison. The first link member 1310 iscoupled to a second link member 1312 that is configured to rotaterelative to the first link member 1310. The second link member 1312 iscoupled to the proximal end 1172 a of the pusher shaft 1170 such that itmay also rotate relative to the pusher shaft 1170, and thusinterconnects the first link member 1310 and the proximal end 1172 a ofthe pusher shaft 1170. Accordingly, rotation of the third capstan 1002 c(via actuation of the third drive input 906 c) will control linearmovement of the pusher 1120 within the shaft 602 and thereby controlloading of surgical clips 1108 into the opposed jaw members 1104,1106 asdesired. It will be appreciated, however, that that the pusher 1120 maybe differently configured, for example, to be actuated by any of theother capstans and corresponding drive inputs and/or with a geararrangement in lieu of the linkage assembly, without departing from thepresent disclosure.

FIGS. 14A-14E are progressive isometric views of the end effector 1102during example operation, according to one or more embodiments. FIG. 14Aillustrates the end effector 1102 prior to actuation where the indexer1118 and the pusher 1120 are retracted within the bore 1113 towards theproximal end 1112 a of the body 1110. In this position, the revolver1114 is fully seated within the camming grooves 1136 of the body 1110and the spring 1160 biases the revolver 1114 proximally to enable theguides 1128 to be received within the camming grooves 1136. In theembodiment illustrated in FIG. 14A, it is assumed that the distal-mostclip 1208 d of the surgical clips 1108 is rotationally aligned with theopposed jaw members 1104,1106 (FIG. 14D) when the revolver 1114 isconstrained in the camming grooves 1136, such that the pusher 1120 maydeploy the distal-most clip 1108 d before the revolver has indexed, ashereinafter described. However, in other embodiments, the distal-mostclip 1208 d is not rotationally aligned with the opposed jaw members1104,1106 when the revolver 1112 is fully seated, but requires that theend effector 1102 be actuated to index the revolver 1114 to align thedistal-most clip 1208 d with the jaw members 1104,1106, before actuatingthe pusher 1120 to deploy the distal-most clip 1208 d.

In FIG. 14B, the end effector 1102 is actuated to cause distaltranslation of the indexer 1118 to properly orient the distal-mostsurgical clip 1108 for deployment into the opposed jaw members 1104,1106(FIG. 14D). Upon actuation, the indexer 1118 slides distally such thatthe cams 1150 make contact with the cams 1126 of the revolver 1114,which correspondingly drives the revolver 1114 distally and the guides1128 of the revolver 1114 slide distally within the camming grooves1136. Rotation of the revolver 1114 is inhibited when the guides 1128are within the camming grooves 1136. In embodiments where the surgicalclips 1108 align with the opposed jaws 1104,1106 when the revolver 1114is constrained in the camming grooves 1136, the pusher 1120 may deploythe distal-most clip 1108 d before the revolver 1114 is indexed.However, in embodiments where the distal-most clip 1208 d is notrotationally aligned with the opposed jaws 1104,1106 when the revolver1114 is constrained in the camming grooves 1136, the pusher 11120deploys the distal-most surgical clip 1208 d after the revolver 1114 isrotated.

In FIG. 14C, the revolver 1114 rotates to index the distal-most clip1208 d (FIG. 14D) into alignment with the opposed jaw members 1104,1106(FIG. 14D) as the indexer 1118 continues to distally drive the revolver1114. More specifically, the revolver 1114 may be able to rotate oncethe guides 1128 exit the camming grooves 1136 and the camming surface1126′ (FIG. 14A) of each cam 1126 is able to slidably engage thecorresponding camming surfaces 1150′ (FIG. 14A) of the cams 1150, whichfacilitates (urges) rotation of the revolver 1114. The revolver 1114continues to rotate until the cams 1126 bottom out in the cams 1150. Inembodiments where the distal-most clip 1208 d is not rotationallyaligned with the opposed jaw members 1104,1106 (FIG. 14D) when therevolver 1112 is seated within the camming grooves 1136, the distal-mostclip 1208 d will be in alignment with the opposed jaw members 1104,1106and the pusher 1120 once the revolver 1114 finishes rotating. In otherembodiments where the distal-most clip 1208 d is rotationally alignedwith the opposed jaw members 1104,1106 (FIG. 14D) when the revolver 1112is seated within the camming grooves 1136, the next distal-most surgicalclip 1108 (e.g., the intermediate clip 1208 c) will be in alignment theopposed jaw members 1104,1106 and the pusher 1120 once the revolver 1114finishes rotating.

Once the distal-most clip 1208 d is aligned with the opposed jaw members1104,1106 (FIG. 14D), the pusher 1120 may be actuated to deploy thedistal-most clip 1208 d.

In FIG. 14D, the pusher 1120 is actuated distally and the pushingelements 1174,1176 are correspondingly moved to engage the aligneddistal-most surgical clip 1208 d at the crown 1108′ thereof. The crown1108′ may include a pair of arms 1474,1476 configured to receive thecorresponding pushing elements 1174,1176. Here, the arms 1474,1476 ofthe crown 1108′ are angled and the pushing elements 1174,1176 havecontact surfaces 1174′,1176′ that are correspondingly angled andcontoured to make complete contact therewith. It will be appreciated,however, that the crown 1108′ may have various geometries and,therefore, that the contact surfaces 1174′,1176′ of the pusher 1120 maybe contoured with various corresponding geometries. In addition, thecontact surfaces 1174′,1176′ may include various features to inhibitslipping of the pushing elements 1174,1176 when engaging the crown1108′. For example, the contact surfaces 1174′,1176′ may include barbs,ridges, and/or an elastomeric element that may increase friction whenengaged with the surgical clips 1108.

Once the distal-most clip 1208 d is deployed and positioned between theopposed jaw members 1104,1106, both the revolver 1114 and the indexer1118 may be retracted proximally into the bore 1113 of the body 1110.

In FIG. 14E, the indexer 1118 is shown being retracted proximally intothe bore 1113, which allows the spring 1160 to push the revolver 1114proximally, and thereby causing the revolver 1114 to follow the indexer1118 as it (i.e., the indexer 1118) translates proximally into the body1110. Moreover, the guides 1128 of the revolver 1114 enter angularlyadjacent camming grooves 1136 as the spring 1160 pushes the revolver1114 proximally into the bore 1113. During this process, the cammingsurfaces 1128′ of the guides 1128 slide upon the corresponding cammingsurfaces 1136′ of the camming grooves 1136 to rotate the revolver 1114so that the guides 1128 properly align with the angularly adjacentcamming grooves 1136, and permits further axial translation of therevolver 1114.

Once the revolver 1114 rotates, the spring 1160 continues to proximallypush the revolver 1114 until the revolver 1114 is seated within the body1110 such that the guides 1128 are fully engaged in the appropriatecamming grooves 1136. Seating the revolver 1114 in this positionsimultaneously places the penultimate clip 1208 c into alignment withthe opposed jaw members 1104,1106 (FIG. 14D) for deployment therein viasubsequent actuation of the indexer 1118. In other embodiments, however,subsequent actuation of the indexer 1118 may be needed to rotate thepenultimate clip 1208 c into alignment with the opposed jaw members1104,1106 (FIG. 14D) prior to deployment via the pusher 1120. Also inthe illustrated embodiment, the guides 1128 of the revolver 1114 arealready rotated into alignment with the camming grooves 1136 of the body1110 such that the spring 1160 may fully seat the guides 1128 into thecamming grooves 1136 of the body 1110 without any obstruction andcamming action between the guides 1128 and the camming grooves 1136. Inother embodiments, however, additional camming action between thecamming surfaces 1128′ of the guides 1128 and the corresponding cammingsurfaces 1136′ of the camming grooves 1136 facilitates fully seating theguides 1128 within the camming grooves 1136.

FIG. 15 is an enlarged isometric view of another example end effector1502, according to one or more embodiments of the present disclosure.The end effector 1502 may be similar in some respects to the endeffector 1102 of FIG. 11, and thus may be incorporated into either orboth of the surgical tools 200, 600 described herein above. Moreover,the end effector 1502 may comprise a clip applier having opposed jawmembers 1504 and 1506 configured to collapse toward one another to crimpa surgical clip 1508 (four shown). As described herein, the end effector1502 may incorporate various component parts and actuatable mechanismsor features that facilitate the feeding of the surgical clip 1508 intothe opposed jaw members 1504,1506 and collapsing the opposed jaw members1504,1506 to crimp the surgical clip 1508 when desired.

The end effector 1502 extends along a longitudinal axis A₄ and includesan elongate body 1510, a revolver 1512, a torsion member 1514, and apusher 1516. The pusher 1516 may be longitudinally actuatable (movable)to index (rotate) the revolver 1512 and thereby selectively deploy thesurgical clips 1508 housed within the revolver 1512. To accomplish this,the pusher 1516 may be operatively coupled to a drive input of a drivehousing, such as one of the drive housings 206, 608 of FIGS. 2 and 6,respectively. In such embodiments, pusher 1516 may be operativelycoupled to the second or third drive and driven gears 502 b,c, 504 b,cof FIG. 5 or one of the rotatable capstans 1002 b-f of FIG. 10. Theopposed jaw members 1504,1506 may each define a groove 1504′,1506′ thattogether define a path, slot, or track that the surgical clips 1508travel as the pusher 1516 feeds them into interposition between theopposed jaw members 1504,1506 from the revolver 1512.

The body 1510 is generally cylindrical and includes a proximal end 1518a and a distal end 1518 b. Moreover, the body 1510 defines a bore 1520that extends between the proximal and distal ends 1518 a,1518 b and issized to receive the revolver 1512 and the torsion member 1514 therein.The revolver 1512 may be adapted for rotation within the body 1510 andabout the longitudinal axis A₄, as described below.

The torsion member 1514 may comprise a torsion spring that includes afirst end 1522 a and a second end 1522 b, and may be configured tobuild/store mechanical energy when the first and second ends 1522 a,1522b are twisted relative to each other. However, the torsion member 1514may comprise other structures or materials in lieu of, or in additionto, the torsion spring, without departing from the present disclosure.As illustrated, the body 1510 defines an aperture 1524 through which thefirst end 1522 a of the torsion member 1514 extends to enable therevolver 1512 to be “spring loaded” when installed within the bore 1520,as hereinafter described.

The pusher 1516 may be configured to longitudinally translate at leastpartially through the body 1510 and the revolver 1512 to selectivelydeploy the surgical clips 1508 into the opposed jaw members 1504,1506 asdesired. Similar to the pusher 1120 of FIG. 11, the pusher 1516 is forkshaped and includes a pair of opposed pushing elements 1526 a,1526 bthat extend distally. The pushing elements 1526 a,1526 b may be alignedwith the opposed jaw members 1504,1506, respectively, and therefore maybe capable of engaging and distally moving the surgical clips 1508 intointerposition therebetween.

The pusher 1516 may be actuated to distally drive one of the surgicalclips 1508 into the opposed jaw members 1504,1506. In some embodiments,the pusher 1516 is operatively coupled to one or more of the capstans1002 b-f within the drive housing 608 (FIGS. 6 and 13). For example, thepusher 1516 may include a shaft that extends proximally through theelongate shaft 602 and is coupled to one or more of the capstans 1002within the drive housing 608 via a linkage assembly or rack and pinioninterface. In one embodiment, the shaft of the pusher 1516 extends intothe drive housing 608 and is coupled to the rack gear 1306 that isconfigured to mesh and interact with the spur gear 1008 operativelycoupled to the fourth capstan 1002 d (FIGS. 6 and 13). In anotherembodiment, the shaft of the pusher 1516 extends into the drive housing608 and is operatively coupled to the third capstan 1002 c via the firstlink member 1310 and the second link member 1312 (FIGS. 6 and 13).However, the pusher 1516 may be differently reciprocated withoutdeparting from the present disclosure.

The pusher 1516 further includes one or more features that may helpguide the pusher 1516 within the revolver 1512. In the illustratedembodiment, the pusher 1516 includes a pair of opposed studs 1528 a and1528 b (obscured from view) that extend laterally from the opposedpushing elements 1526 a,1526 b, respectively. It will be appreciatedthat more or less than the pair of studs 1528 a,1528 b may be utilized,without departing from the present disclosure. Moreover, it will beappreciated that the pair of studs 1528 a,1528 b (or any of them) mayinclude different geometries and/or be differently arranged on thepusher 1516 without departing from the present disclosure.

FIG. 16 is an enlarged isometric cross-sectional view of the revolver1512, according to one or more embodiments of the present disclosure. Asillustrated, the revolver 1512 comprises a revolver body 1530 that hasan open proximal end 1532 a, an open distal end 1532 b, and a bore 1534extending there-between. The revolver body 1530 may be cylindricallyshaped and sized to be received within the body 1510 (FIG. 15). In otherembodiments, however, the revolver body 1530 may include othergeometries, without departing from the present disclosure. In someembodiments, the revolver 1512 is disposed within the body 1510 with theopen distal end 1532 b extending past the distal end 1518 b (FIG. 15) ofthe body 1510 and arranged proximate to the opposed jaw member1504,1506. In other embodiments, however, the open distal end 1532 b maybe arranged within the body 1510 and otherwise proximal to the distalend 1518 b of the body 1510.

The revolver 1512 includes a detent or spline 1536 configured to receiveand abut the second end 1522 b (FIG. 15) of the torsion member 1514(FIG. 15) such that the torsion member 1514 is able to retain tensionwhen its first and second ends 1522 a,1522 b are twisted. Accordingly,the torsion member 1514 imparts a constant torsion load on the revolver1512 when twisted out of an equilibrium position, thereby urging therevolver 1512 to rotate about the longitudinal axis A₄.

In the illustrated embodiment, the spline 1536 is provided or otherwisedefined on the revolver 1114 and arranged to abut the second end 1522 bof the torsion member 1514. Here, the spline 1536 extends radially fromthe revolver body 1530 and includes a front face 1538 a and rear face1538 b. In addition, the spline 1536 defines a recess 1540 that allowsthe torsion member 1514 to extend around the spline 1536 such that thesecond end 1522 b thereof may abut the rear face 1538 b. Thus, thetorsion member 1514 may retain tension when impinged between theaperture 1524 (FIG. 15) of the body 1510 (FIG. 15) and the spline 1536of the revolver 1512. Moreover, the spline 1536 extends substantiallyparallel to the longitudinal axis A₄.

The revolver 1512 includes a plurality of discrete regions arrangedwithin the bore 1534. As illustrated, a clip region 1550 is formedwithin the bore 1534 and configured to receive one or more of thesurgical clips 1508. In operation, the surgical clips 1508 are stackedwithin the clip region 1550 in a nested helical array. The clip region1550 defines a plurality of clip slots 1552 defined into the innersurface of the bore 1534. Each clip slot 1552 may be configured toreceive one leg of a given surgical clip 1508 and may be angularlyopposite an opposing clip slot 1504 configured to receive the second legof the given surgical clip 1508. Consequently, a pair of angularlyopposite clips slots 1552 may be configured to receive and seat a singlesurgical clip 1508. In the illustrated embodiment, the clip region 1550includes eight clip slots 1552 equidistantly spaced about the bore 1534and thereby capable of receiving a corresponding four surgical clips1508 stacked in a helical array. It will be appreciated, however, thatmore or less than four surgical clips 1508 may be housed within therevolver 1512 without departing from the present disclosure. The angularspacing and orientation of the clip slots 1552 helps the surgical clips1508 to be arranged in a nested helical array, as illustrated.

In the illustrated example, the surgical clips 1508 include aproximal-most clip 1508 a, a pair of intermediate clips 1508 b,1508 c,and a distal-most surgical clip 1508 d. To load the revolver 1512, theproximal-most clip 1508 a is first inserted into a first pair of clipslots 1552. The first intermediate clip 1508 b is then inserted into asecond pair of clip slots 1552 angularly offset from the first pair ofclip slots 1552, the second intermediate clip 1508 c is inserted into athird pair of clip slots 1552 angularly offset from the second pair ofclip slots 1552, and the distal-most surgical clip 1508 d is insertedinto a fourth pair of clip slots 1552 angularly offset from the thirdpair of clip slots 1552. Thus, the clip slots 1552 orient the surgicalclips 1508 a-1508 d in a helical array when stacked/stored within theclip region 1550. It will be appreciated, however, that the clip region1550 may be differently configured with more or less clip slots 1552 tohouse any number of the surgical clips 1508 in various orientationswithout departing from the present disclosure.

The revolver 1512 also includes a biasing region 1560 configured toguide the pusher 1516 (FIG. 15). The biasing region 1560 extends intothe bore 1534 at the open proximal end 1532 a and terminates at or nearthe clip region 1550. As hereinafter described, the pusher 1516 may beconfigured to engage the biasing region 1560 and help index the revolver1512 as it traverses the biasing region 1560.

As illustrated, the biasing region 1560 includes a plurality of biasinggrooves 1562 (referred to hereinafter as a “plurality of grooves”)configured to receive and guide the pusher 1516 (FIG. 15) as itreciprocates distally and proximally within the bore 1534. Eachangularly opposite pair of the grooves 1562 may be axially aligned witha corresponding angularly opposite pair of the clip slots 1552 of theclip region 1550. The studs 1528 a,1528 b (FIG. 15) of the pusher 1516may be configured to selectively and sequentially traverse within eachpair of the grooves 1562 so that the pushing elements 1526 a,1526 b arealigned to drive each surgical clip 1508 into the opposed jaw members1504,1506. The illustrated embodiment includes four pairs of grooves1562 that each correspond with one of the four pairs of clip slots 1552.In other embodiments, however, more or less than four pairs of grooves1562 (and corresponding pairs of clip slots 1552) may be utilized.

Each of the pairs of grooves 1562 includes a proximal portion 1564 a, adistal portion 1564 b, and a connecting channel 1566 that interconnectsthe proximal and distal portions 1564 a,1564 b of each groove 1562 andthereby provides a pathway that connects each groove 1562 to anangularly adjacent (neighboring) groove 1562. The proximal portion 1564a, the distal portion 1564 b, and the connecting channel 1566 are eacharranged to slidably receive the studs 1528 a,1528 b (FIG. 15) of thepusher 1516, which in turn rotates the revolver 1512 within the body1510 as the pusher 1516 traverses the groove 1562. Thus, the connectingchannel 1566 connect angularly adjacent pairs of grooves 1562 andfacilitate rotation of the revolver 1512 when the studs 1528 a,1528 btravel into the angularly adjacent pair of grooves 1562.

In the illustrated embodiment, the pairs of grooves 1562 include a firstpair of grooves 1562 a, a second pair of grooves 1562 b, a third pair ofgrooves 1562 c, and a fourth pair of grooves 1562 d. Here, a first ofthe connecting channels 1566 connects the first pair of grooves 1562 ato its neighboring second and fourth pairs of grooves 1562 b,1562 d; asecond of the connecting channels 1566 connects the second pair ofgrooves 1562 b to its neighboring first and third pairs of grooves 1562a,1562 c; a third of the connecting channels 1566 connects the thirdpair of grooves 1562 c to its neighboring second and fourth pairs ofgrooves 1562 b,1562 d; and a fourth of the connecting channels 1566connects the fourth pair of grooves 1562 d to its neighboring third andfirst pairs of grooves 1562 c,1562 a.

The revolver 1512 is constantly biased to rotate in an attempt torelieve the torsional load (spring force) built up in the torsion member1514. As the pusher 1516 advances distally, the studs 1528 a,1528 b areable to bypass (traverse) the connecting channels 1566 in the distaldirection and, therefore, remain in the same pair of grooves 1562 tothereby engage the distal-most surgical clip 1508 d and discharge itfrom the revolver 1512. However, upon retracting the pusher 1516 in theproximal direction, the torsional load provided by the torsion member1514 forces the studs 1528 a,1528 b to enter and follow the connectingchannels 1566, which allows the revolver 1512 to rotate and place thestuds 1528 a,1528 b in the angularly adjacent pair of grooves 1562.Allowing the revolver 1512 to rotate where the studs 1528 a,1528 b arepositioned in the angularly adjacent pair of grooves 1562 simultaneouslyaligns the penultimate surgical clip 1508 with the pusher 1516. Thisprocess is repeated to discharge the penultimate surgical clip 1508 fromthe revolver 1512.

FIGS. 17A-17B are isometric views of the end effector 1502 showingexample operation, according to one or more embodiments of the presentdisclosure. In FIG. 17A, the pusher 1516 is shown being moved in adistal direction 1702 to engage and drive the distal-most surgical clip1508 d from its respective clip slot 1552 (FIG. 16) within the revolver1512 and into the grooves 1504′,1506′ defined in the opposed jaw members1504,1506. While not fully illustrated, the studs 1528 a,1528 b of thepusher 1516 are engaged within the distal portion 1564 b (FIG. 16) ofthe groove 1562 (FIG. 16) that are aligned with the grooves 1504′,1506′(e.g., the third pair of grooves 1562 c of FIG. 16).

FIG. 17B illustrates the pusher 1516 as it moves in a proximal direction1704 relative to the revolver 1512. Moving the pusher 1516 in theproximal direction 1704 allows the revolver 1512 to index or rotate in acounter-clockwise direction 1706. More specifically, the torsion member1514 is installed in the end effector 1502 and twisted to build up atorsional load that continuously biases the revolver 1512 in thecounter-clockwise direction 1706. Rotation of the revolver 1512 isconstrained when the studs 1528 a,1528 b of the pusher 1516 are engagedwithin the distal portion 1564 b of the groove 1562 (e.g., the thirdpair of grooves 1562 c (FIG. 16)). Once the pusher 1516 moves in theproximal direction 1704 a sufficient distance such the studs 1528 a,1528b (FIG. 17A) are no longer engaged within the distal portion 1564 bthereof, rotation of the revolver 1512 is no longer inhibited and thetorsion member 1514 rotates the revolver 1512 in the counter-clockwisedirection 1706 such that the studs 1528 a,1528 b enter the connectingchannels 1566. The connecting channels 1566 direct the studs 1528 a,1528b in a downward path 1708 so that they enter the proximal portion 1564 aof the angularly adjacent pair of grooves 1562 (e.g., the second pair ofgrooves 1562 b (FIG. 16)), which simultaneously aligns the penultimatesurgical clip 1508 with the pusher 1516. The pusher 1516 may thenadvance distally in the angularly adjacent pair of grooves 1562, withthe studs 1528 a,1528 b bypassing (traversing) the connecting channels1566 and remaining in the same pair of grooves 1562, to engage thepenultimate surgical clip 1508 and discharge it from the revolver 1512.This process may be repeated to discharge the next penultimate surgicalclip 1508 from the revolver 1512.

Embodiments disclosed herein include:

A. An end effector for a surgical clip applier that includes an elongatebody, a clip revolver rotatably positioned within the elongate body andproviding an inner bore that defines a plurality of clip slots angularlyspaced from each other about an inner surface of the inner bore, whereina plurality of surgical clips are receivable within the plurality ofclip slots in a nested helical array, a clip advancer longitudinallymovable within the elongate body and selectively engageable with eachsurgical clip based on rotation of the clip revolver, and first andsecond jaw members extending past a distal end of the elongate body andaligned to receive axially-aligned surgical clips from the clip revolveras the clip advancer advances distally, wherein the clip revolver isrotatable to sequentially align each surgical clip with the first andsecond jaw members.

B. A method of operating an end effector of a surgical clip applier thatincludes positioning the end effector adjacent a patient for operation,the end effector including an elongate body, a clip revolver rotatablypositioned within the elongate body and providing an inner bore thatdefines a plurality of clip slots angularly spaced from each other aboutan inner surface of the inner bore, a plurality of surgical clipsarranged within the plurality of clip slots in a nested helical array, aclip advancer longitudinally movable within the elongate body, and firstand second jaw members extending past a distal end of the elongate body.The method further including distally advancing the clip advancer toengage a distal-most surgical clip of the plurality of surgical clips,distally advancing the distal-most surgical clip out of the cliprevolver and into interposition between the first and second jaw memberswith the clip advancer, and collapsing the first and second jaw membersto crimp the distal-most surgical clip.

C. A surgical clip applier that includes a drive housing, an elongateshaft that extends from the drive housing, and an end effector arrangedat a distal end of the elongate shaft, the end effector including anelongate body, a clip revolver rotatably positioned within the elongatebody and providing an inner bore that defines a plurality of clip slotsangularly spaced from each other about an inner surface of the innerbore, wherein a plurality of surgical clips are receivable within theplurality of clip slots in a nested helical array, a clip advancerlongitudinally movable within the elongate body and selectivelyengageable with each surgical clip based on rotation of the cliprevolver, and first and second jaw members extending past a distal endof the elongate body and aligned to receive axially-aligned surgicalclips from the clip revolver as the clip advancer advances distally,wherein the clip revolver is rotatable to sequentially align eachsurgical clip with the first and second jaw members.

Each of embodiments A, B, and C may have one or more of the followingadditional elements in any combination: Element 1: further comprising anindexer longitudinally movable within the elongate body and engageablewith the clip revolver to rotate the clip revolver. Element 2: whereinthe indexer includes one or more rails that are received within one ormore corresponding guides provided in an inner surface of the elongatebody. Element 3: wherein a camming surface of the indexer is engageablewith a corresponding camming surface of the clip revolver to rotate theclip revolver. Element 4: further comprising a plurality ofaxially-extending camming grooves provided on an inner radial surface ofthe body, and a plurality of guides extending radially from an outersurface of the clip revolver and receivable within the plurality ofcamming grooves. Element 5: further comprising a biasing member arrangedwithin the body to bias the plurality of guides into the plurality ofcamming grooves. Element 6: further comprising a torsion memberoperatively coupled to the elongate body and the clip revolver andimparting a torsional load on the clip revolver that urges the cliprevolver to rotate relative to the elongate body, a plurality ofaxially-extending grooves defined on the inner bore of the cliprevolver, one or more studs extending laterally from the clip advancerand receivable within the plurality of axially-extending grooves toprevent the clip revolver from rotating, and a channel groove thatinterconnects angularly adjacent axially-extending grooves of theplurality of axially-extending grooves. Element 7: wherein the one ormore studs bypass the channel groove as the clip advancer advancesdistally within a given axially-extending groove of the plurality ofaxially-extending grooves, wherein the one or more studs are receivedwithin the channel groove as the clip advancer retracts proximallywithin the given axially-extending groove, and wherein the torsionalload rotates the clip revolver and forces the one or more studs to enterand follow an angularly adjacent axially-extending groove of theplurality of axially-extending grooves. Element 8: wherein the pluralityof clip slots forms pairs of angularly opposite clip slots, and eachpair of angularly opposite clip slots receives a corresponding one ofthe plurality of surgical clips, and wherein the plurality of surgicalclips are receivable within the pairs of clip slots such that eachsurgical clip resides in a different radial plane relative to alongitudinal axis of the end effector. Element 9: wherein the pluralityof surgical clips are angularly offset from each other within the pairsof clips slots, and wherein the revolver is rotatable to sequentiallyalign the pairs of clips slots with the first and second jaw members.Element 10: wherein the plurality of surgical clips are receivablewithin the plurality of clip slots such that a crown of more proximalsurgical clips are stacked upon a crown of more distal surgical clips,and legs of the more proximal surgical clips extend past the crown ofthe more distal surgical clips.

Element 11: further comprising rotating the clip revolver from a firstposition to a second position where a penultimate surgical clip of theplurality of surgical clips aligns with the first and second jawmembers. Element 12: wherein a plurality of guides extend radially froman outer surface of the clip revolver and a plurality ofaxially-extending camming grooves are provided in an inner radialsurface of the elongate body, the method further comprising maintainingthe clip revolver in the first position by biasing the plurality ofguides into the plurality of axially-extending camming grooves, anddistally advancing the clip revolver such that the plurality of guidesexit the plurality of camming grooves and thereby allow the cliprevolver to rotate from the first position to the second position.Element 13: wherein the end effector further includes a torsion memberoperatively coupled to the elongate body and the clip revolver, aplurality of axially-extending grooves defined on the inner bore of theclip revolver, and a channel groove that interconnects angularlyadjacent axially-extending grooves of the plurality of axially-extendinggrooves, the method further comprising imparting a torsional load on theclip revolver with the torsion member and thereby urging the cliprevolver to rotate away from the first position, and maintaining theclip revolver in the first position with one or more studs extendinglaterally from the clip advancer and received within the plurality ofaxially-extending grooves. Element 14: further comprising when therevolver is in the first position, bypassing the channel groove with theone or more studs as the clip advancer advances distally within a givenaxially-extending groove of the plurality of axially-extending grooves,receiving the one or more studs within the channel groove as the clipadvancer retracts proximally within the given axially-extending groove,rotating the clip revolver to the second position with the torsionalload once the one or more studs enter the channel groove, and receivingthe one or more studs within an angularly adjacent axially-extendinggroove of the plurality of axially-extending grooves. Element 15:further comprising distally advancing the penultimate surgical clip outof the clip revolver and into interposition between the first and secondjaw members, and collapsing the first and second jaw members to crimpthe penultimate surgical clip.

Element 16: further comprising an articulable wrist joint interposingthe end effector and the elongate shaft. Element 17: wherein theplurality of clip slots forms pairs of angularly opposite clip slots,and each pair of angularly opposite clip slots receives a correspondingone of the plurality of surgical clips, and wherein the plurality ofsurgical clips are receivable within the pairs of clip slots such thateach surgical clip resides in a different radial plane relative to alongitudinal axis of the end effector.

By way of non-limiting example, exemplary combinations applicable to A,B, and C include: Element 1 with Element 2; Element 1 with Element 3;Element 3 with Element 4; Element 4 with Element 5; Element 6 withElement 7; Element 8 with Element 9; Element 8 with Element 10; Element11 with Element 12; Element 11 with Element 13; and Element 14 withElement 15.

Therefore, the disclosed systems and methods are well adapted to attainthe ends and advantages mentioned as well as those that are inherenttherein. The particular embodiments disclosed above are illustrativeonly, as the teachings of the present disclosure may be modified andpracticed in different but equivalent manners apparent to those skilledin the art having the benefit of the teachings herein. Furthermore, nolimitations are intended to the details of construction or design hereinshown, other than as described in the claims below. It is thereforeevident that the particular illustrative embodiments disclosed above maybe altered, combined, or modified and all such variations are consideredwithin the scope of the present disclosure. The systems and methodsillustratively disclosed herein may suitably be practiced in the absenceof any element that is not specifically disclosed herein and/or anyoptional element disclosed herein. While compositions and methods aredescribed in terms of “comprising,” “containing,” or “including” variouscomponents or steps, the compositions and methods can also “consistessentially of” or “consist of” the various components and steps. Allnumbers and ranges disclosed above may vary by some amount. Whenever anumerical range with a lower limit and an upper limit is disclosed, anynumber and any included range falling within the range is specificallydisclosed. In particular, every range of values (of the form, “fromabout a to about b,” or, equivalently, “from approximately a to b,” or,equivalently, “from approximately a-b”) disclosed herein is to beunderstood to set forth every number and range encompassed within thebroader range of values. Also, the terms in the claims have their plain,ordinary meaning unless otherwise explicitly and clearly defined by thepatentee. Moreover, the indefinite articles “a” or “an,” as used in theclaims, are defined herein to mean one or more than one of the elementsthat it introduces. If there is any conflict in the usages of a word orterm in this specification and one or more patent or other documentsthat may be incorporated herein by reference, the definitions that areconsistent with this specification should be adopted.

As used herein, the phrase “at least one of” preceding a series ofitems, with the terms “and” or “or” to separate any of the items,modifies the list as a whole, rather than each member of the list (i.e.,each item). The phrase “at least one of” allows a meaning that includesat least one of any one of the items, and/or at least one of anycombination of the items, and/or at least one of each of the items. Byway of example, the phrases “at least one of A, B, and C” or “at leastone of A, B, or C” each refer to only A, only B, or only C; anycombination of A, B, and C; and/or at least one of each of A, B, and C.

What is claimed is:
 1. An end effector for a surgical clip applier,comprising: an elongate body; a clip revolver rotatably positionedwithin the elongate body and providing an inner bore that defines aplurality of clip slots angularly spaced from each other about an innersurface of the inner bore, wherein a plurality of surgical clips arereceivable within the plurality of clip slots in a nested helical array;a clip advancer longitudinally movable within the elongate body andselectively engageable with each surgical clip based on rotation of theclip revolver; and first and second jaw members extending past a distalend of the elongate body and aligned to receive axially-aligned surgicalclips from the clip revolver as the clip advancer advances distally,wherein the clip revolver is rotatable to sequentially align eachsurgical clip with the first and second jaw members.
 2. The end effectorof claim 1, further comprising an indexer longitudinally movable withinthe elongate body and engageable with the clip revolver to rotate theclip revolver.
 3. The end effector of claim 2, wherein the indexerincludes one or more rails that are received within one or morecorresponding guides provided in an inner surface of the elongate body.4. The end effector of claim 2, wherein a camming surface of the indexeris engageable with a corresponding camming surface of the clip revolverto rotate the clip revolver.
 5. The end effector of claim 4, furthercomprising: a plurality of axially-extending camming grooves provided onan inner radial surface of the body; and a plurality of guides extendingradially from an outer surface of the clip revolver and receivablewithin the plurality of camming grooves.
 6. The end effector of claim 5,further comprising a biasing member arranged within the body to bias theplurality of guides into the plurality of camming grooves.
 7. The endeffector of claim 1, further comprising: a torsion member operativelycoupled to the elongate body and the clip revolver and imparting atorsional load on the clip revolver that urges the clip revolver torotate relative to the elongate body; a plurality of axially-extendinggrooves defined on the inner bore of the clip revolver; one or morestuds extending laterally from the clip advancer and receivable withinthe plurality of axially-extending grooves to prevent the clip revolverfrom rotating; and a channel groove that interconnects angularlyadjacent axially-extending grooves of the plurality of axially-extendinggrooves.
 8. The end effector of claim 7, wherein the one or more studsbypass the channel groove as the clip advancer advances distally withina given axially-extending groove of the plurality of axially-extendinggrooves, wherein the one or more studs are received within the channelgroove as the clip advancer retracts proximally within the givenaxially-extending groove, and wherein the torsional load rotates theclip revolver and forces the one or more studs to enter and follow anangularly adjacent axially-extending groove of the plurality ofaxially-extending grooves.
 9. The end effector of claim 1, wherein theplurality of clip slots forms pairs of angularly opposite clip slots,and each pair of angularly opposite clip slots receives a correspondingone of the plurality of surgical clips, and wherein the plurality ofsurgical clips are receivable within the pairs of clip slots such thateach surgical clip resides in a different radial plane relative to alongitudinal axis of the end effector.
 10. The end effector of claim 9,wherein the plurality of surgical clips are angularly offset from eachother within the pairs of clips slots, and wherein the revolver isrotatable to sequentially align the pairs of clips slots with the firstand second jaw members.
 11. The end effector of claim 9, wherein theplurality of surgical clips are receivable within the plurality of clipslots such that a crown of more proximal surgical clips are stacked upona crown of more distal surgical clips, and legs of the more proximalsurgical clips extend past the crown of the more distal surgical clips.12. A method of operating an end effector of a surgical clip applier,comprising: positioning the end effector adjacent a patient foroperation, the end effector including: an elongate body; a clip revolverrotatably positioned within the elongate body and providing an innerbore that defines a plurality of clip slots angularly spaced from eachother about an inner surface of the inner bore; a plurality of surgicalclips arranged within the plurality of clip slots in a nested helicalarray; a clip advancer longitudinally movable within the elongate body;and first and second jaw members extending past a distal end of theelongate body; distally advancing the clip advancer to engage adistal-most surgical clip of the plurality of surgical clips; distallyadvancing the distal-most surgical clip out of the clip revolver andinto interposition between the first and second jaw members with theclip advancer; and collapsing the first and second jaw members to crimpthe distal-most surgical clip.
 13. The method of claim 12, furthercomprising rotating the clip revolver from a first position to a secondposition where a penultimate surgical clip of the plurality of surgicalclips aligns with the first and second jaw members.
 14. The method ofclaim 13, wherein a plurality of guides extend radially from an outersurface of the clip revolver and a plurality of axially-extendingcamming grooves are provided in an inner radial surface of the elongatebody, the method further comprising: maintaining the clip revolver inthe first position by biasing the plurality of guides into the pluralityof axially-extending camming grooves; and distally advancing the cliprevolver such that the plurality of guides exit the plurality of camminggrooves and thereby allow the clip revolver to rotate from the firstposition to the second position.
 15. The method of claim 13, wherein theend effector further includes a torsion member operatively coupled tothe elongate body and the clip revolver, a plurality ofaxially-extending grooves defined on the inner bore of the cliprevolver, and a channel groove that interconnects angularly adjacentaxially-extending grooves of the plurality of axially-extending grooves,the method further comprising: imparting a torsional load on the cliprevolver with the torsion member and thereby urging the clip revolver torotate away from the first position; and maintaining the clip revolverin the first position with one or more studs extending laterally fromthe clip advancer and received within the plurality of axially-extendinggrooves.
 16. The method of claim 15, further comprising: when therevolver is in the first position, bypassing the channel groove with theone or more studs as the clip advancer advances distally within a givenaxially-extending groove of the plurality of axially-extending grooves;receiving the one or more studs within the channel groove as the clipadvancer retracts proximally within the given axially-extending groove;rotating the clip revolver to the second position with the torsionalload once the one or more studs enter the channel groove; and receivingthe one or more studs within an angularly adjacent axially-extendinggroove of the plurality of axially-extending grooves.
 17. The method ofclaim 12, further comprising: distally advancing the penultimatesurgical clip out of the clip revolver and into interposition betweenthe first and second jaw members; and collapsing the first and secondjaw members to crimp the penultimate surgical clip.
 18. A surgical clipapplier, comprising: a drive housing; an elongate shaft that extendsfrom the drive housing; and an end effector arranged at a distal end ofthe elongate shaft, the end effector including: an elongate body; a cliprevolver rotatably positioned within the elongate body and providing aninner bore that defines a plurality of clip slots angularly spaced fromeach other about an inner surface of the inner bore, wherein a pluralityof surgical clips are receivable within the plurality of clip slots in anested helical array; a clip advancer longitudinally movable within theelongate body and selectively engageable with each surgical clip basedon rotation of the clip revolver; and first and second jaw membersextending past a distal end of the elongate body and aligned to receiveaxially-aligned surgical clips from the clip revolver as the clipadvancer advances distally, wherein the clip revolver is rotatable tosequentially align each surgical clip with the first and second jawmembers.
 19. The surgical clip applier of claim 18, further comprisingan articulable wrist joint interposing the end effector and the elongateshaft.
 20. The surgical clip applier of claim 18, wherein the pluralityof clip slots forms pairs of angularly opposite clip slots, and eachpair of angularly opposite clip slots receives a corresponding one ofthe plurality of surgical clips, and wherein the plurality of surgicalclips are receivable within the pairs of clip slots such that eachsurgical clip resides in a different radial plane relative to alongitudinal axis of the end effector.